Questions Answered About Insertional Achilles Tendonitis

Last updated on March 9th, 2024 at 03:13 pm

Achilles tendonitis, or insertional Achilles tendonitis (IAT), can be painful and frustrating. While it can take time to find relief, there are things you can do to reduce your pain and prevent further injury.

Here are some frequently asked questions about insertional Achilles tendonitis that will help you learn more about the condition and find some treatment options that are right for you.

What is insertional Achilles tendonitis and how is it caused?

Insertional Achilles tendonitis is a condition that affects the tendon at the back of the heel. The Achilles tendon is the largest tendon in the human body, and it connects the calf muscle to the heel bone. It is very strong and without it, we would not be able to walk, run or play sports.

The injury usually occurs where the tendon inserts into the heel bone, hence why it is called insertional Achilles tendonitis. Achilles tendonitis can also occur anywhere along the tendon. The mid-portion of the tendon is also a popular place for tendonitis to occur.

What causes it?

There are a few things that can cause insertional Achilles tendonitis or tendinopathy. The first is overuse. If you do a lot of repetitive activities that put stress on your Achilles tendon, it can become inflamed and painful. This is common in runners and other athletes.

It is not that the tendon can not cope with the stress or the load placed on it. It can and does it very well. Your tendons love familiarity. Thus the problem occurs when the workload increases suddenly or too quickly making it less likely to cope with the load and therefore microscopical tears occurs.

Another reason is tight calf muscles. If your calf muscles (soleus and gastrocnemius) are tight, they can put extra strain on the Achilles tendon, leading to inflammation.

It can also be caused by poor footwear choices that don’t provide enough support, or by conditions such as flat feet or high arches. Some individuals with ankle equinus (Reduce range of motion) can also develop insertional Achilles tendonitis. Not to be missed are factors such as age, being female and metabolic syndrome (Pabon and Naqvi, 2023).

How is it diagnosed?

There are a few ways your doctor can diagnose insertional Achilles tendonitis. He or she may ask about your symptoms and do a physical examination. This will help them rule out other conditions that may be causing your pain.

They may also order imaging tests, such as an ultrasound, to look closely at the tendon. If the ultrasound is diagnostic then an MRI maybe requested. In some cases, they may need to do an ultrasound guided biopsy, which involves taking a small sample of tissue from the tendon to be examined under a microscope. This is not very common as a physical examination and imaging are usually enough to confirm diagnosis.

How do you treat insertional Achilles tendonitis?

There are a few ways to treat insertional Achilles tendonitis or tendinopathy. The first step is always to rest the affected area and avoid activities that aggravate the pain. You can also try icing the area for 20 minutes at a time twice daily.

If those measures don’t help, your doctor may recommend wearing a walking boot or using crutches to keep weight off your foot. They may also prescribe physical therapy to stretch and strengthen the muscles and tendons around your ankle.

The tendon is usually strained eccentrically and therefore eccentric strengthening is usually prescribed. Heel drop exercises are generally prescribed based on the Alfredson protocol. This involves rasing and slowly dropping the heels using both legs with knees slightly bent. 180 repetitions should be done daily for a period of twelve 12 weeks.

Footwear with a rocker bottom and heel raise may can be of help in offloading the tendon. An orthotic with arch support and a heel raise post can also be of help. Longitudinal gentle massage may help in realigning the collagen fibres (there are disagreements in current literature).

Corticosteroids injection is not advised for insertional Achilles tendonitis as it can cause tendon rature. Platelet Rich Plasma (PRP) or Prolotherapy may be of benefit and again the evidence for their use is not very strong. In some cases, surgery may be necessary to remove damaged tissue or repair the tendon.

How long does it take to heal?

There is no one-size-fits-all answer to this question, as the healing time for insertional Achilles tendonitis can vary depending on the individual case. However, it is generally recommended that people with this condition rest and avoid activities that aggravate their symptoms for at least six weeks.

Additionally, many people find relief from non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and/or injection therapy as mentioned before.

How common is insertional Achilles tendonitis?

Acording to Ruth Chimenti DPT, 6% of the population reported Achilles tendon rapture. About a third of that population had Insertional Achilles tendonitis. The is condition commonly affects runners. However, the condition is also common among those labelled weekend worriers.

What are the symptoms of insertional Achilles tendonitis?

Insertional Achilles tendonitis is a condition that causes heel pain and also pain in the back of the lower leg. The symptoms can vary from mild to severe, and include redness, swelling and stiffness in the mornings and pain throughout the day that gets worse with activity.

There is also debilitating pain after activity or exercise. The area of then tendon affected will markedly thicker. Osteophytes can also form at the site of injury. Shoes can also irritate and cause pain.

It’s important to know that there are other causes for these symptoms including a fracture or torn ligament; make sure you seek medical attention if you are experiencing any of these symptoms.

Should I massage insertional Achilles tendonitis?

If you’re dealing with insertional Achilles tendonitis, you might be wondering if massaging the area is a good idea. The short answer is: it depends. If the pain is acute, then massaging the area may not be a good idea.

However, if the heel pain is more chronic, massage can help improve blood flow, realign collagen fibres, get rid of wates or dead tissue and increase range of motion. However, consult with your doctor before trying any new treatment.

Conclusion

If you’re dealing with insertional Achilles tendonitis, know that you’re not alone. This condition is relatively common, especially among runners and weekend worriers. While it can be painful and frustrating, there are treatments available that can help you find relief.

If you suspect you have this condition, be sure to see a podiatrist (foot doctor) or certified physical therapist for an accurate diagnosis and treatment plan. Do not suffer alone seek help. Good luck!